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COLLATERAL LIGAMENT INJURIES

In order to better understand medial collateral
ligament (MCL) and lateral collateral ligament (LCL)
injuries, it is important to understand basic knee
anatomy and the function of the MCL and the LCL. Please
review the section on knee
anatomy before reading this section.

Ligaments are like strong ropes that help connect bones
together and provide stability to joints. In the knee,
there are four main ligaments. On the inner (medial)
aspect of the knee is the medial collateral ligament
(MCL) and on the outer (lateral) aspect of the knee is
the lateral collateral ligament (LCL). The other two
main ligaments are found in the center of the knee.
These paired ligaments are called the anterior cruciate
ligament (ACL) and the posterior cruciate ligament
(PCL). They are called cruciate ligaments because the
ACL "crosses" in front of the PCL.

The MCL and the LCL work together with ACL and the PCL
to keep the knee joint stable during movement. The MCL
and LCL provide support at the inner and outer aspects
of the knee while the ACL and the PCL lend support at
the center of the knee. Tears of the MCL or LCL may be
mild (grade I), moderate (grade II) or severe (grade
III). MCL and LCL injuries differ from ACL and PCL
injuries in that mild to moderate tears have the
ability to heal following injury. Grade III injuries to
the MCL or LCL are more serious and are often
associated with other knee injuries.

The MCL is usually injured by a "blow" to the outer
side of the leg (valgus force). A "blow" to the inner
side of the leg (varus force) may injure the LCL. MCL
injuries are far more common than LCL injuries and are
often seen in contact sports. At the time of the injury
there is often immediate pain and sometimes swelling
can occur. A "pop" or "snap" may be felt or heard and
the knee may feel "unstable" during certain movements.

As mentioned previously MCL or LCL injuries can vary in
severity. Tears may be partial (grades I and II) or
complete (grade III). Larger tears result in greater
instability of the knee joint. Injuries to other
structures inside the knee can occur when either the
MCL or LCL are injured. The cartilage (menisci) inside
the knee can be injured as can the ACL or PCL (the
cruciate ligaments). Injuries to other structures are
more likely if there was a significant force or if
there was a rotational component at the time of injury.
A bone injury or fracture can occur, particularly, in
young growing athletes.

Examination techniques that detect side to side
(valgus-varus) looseness in the knee are effective in
detecting collateral ligament tears. Tests that detect
forward-backward (anterior-posterior) or rotational
looseness can help detect other ligament injuries.
X-rays are often done at the time of injury to make
sure the bones of the knee are not broken. Tests such
as Magnetic Resonance Images (MRI) are rarely required
for collateral ligament injuries but are occasionally
used to rule out other injuries to the knee.

The treatment of MCL and LCL injuries depends on the
severity of the injury and other associated injuries.
Each treatment plan should be individualized. Initially
protection (by use of crutches and/or a rehabilitation
brace), rest, ice, compression and elevation (PRICE) of
the injury will help reduce pain and/or swelling.

After an MCL or LCL injury, the long term goal is to
return the individual back to their previous level of
activity. A general knee rehabilitation program which
includes strengthening exercises, flexibility
exercises, aerobic conditioning, technique refinement
and proprioceptive (biofeedback) retraining is the most
important factor in achieving this goal. Some people
with MCL or LCL injuries report an improved sense of
stability when wearing a collateral ligament brace.

Even with the most ideal treatment the knee may never
be as "normal" as the uninjured knee and modification
of activity may be required. However, doctors and
physiotherapists trained in treating MCL and LCL
injuries can outline an individualized treatment plan
which will maximize the long-term function and
stability of the knee.

To read more about collateral ligament braces click here. Please visit the
links
section for additional information on MCL and LCL
injuries. Links have been provided to other websites as
well as online medical journals. Other knee injury
topics can also be accessed.